Wednesday, July 30, 2008

NOT QUITE 24/7

On Sunday I was feeling quite unwell, and thought I was coming down with a cold, so I asked Karen if she could do a postnatal home visit for me. It was good to stay in my nightie and spend a quiet day, rugged up by the fire.

I had agreed to cover for Andrea on Sunday night and Monday, as she was taking the Lactation Consultant (IBCLC) exam. On Monday morning I woke up feeling stronger and was thankful that I had not been called out that night. Shortly thereafter the phone rang, and it was the husband of Andrea's client, who I will call Jen. Jen was having some contractions; her waters had not broken, and she had not noticed a show. She didn't want me to come yet - just wanted to know that I was available for her.
It was not long before Jen's husband rang again and asked me to come. I headed down the new East Link toll road, and found the house without difficulty.
This was Jen's second baby, and she progressed quickly and beautifully. After getting into the bath she asked me if I thought she had long to go. "Not long now" I said. "Are you just saying that?" she asked, with a look of surprise. The next contraction was strong and she felt the unmistakable bulge. I called her husband, and she gave birth in the bath tub to a healthy baby boy. The baby's bag of waters had not broken until after his body had birthed, so I lifted back the membrane as we welcomed the little one.

As I drove home I reflected on midwives covering for each other. We do our very best to be there 24/7, but there are times when we need to be somewhere else. I had conflicting emotions. I felt delighted to be asked to be able to stand in for Andrea, and I was also very happy to be able to ask Karen to cover for me the previous day; yet it was difficult for me to come to that point of acknowledging that I needed to ask for help.

I have chosen to be a solo practitioner, 'independent' within what I consider reasonable limits. It is uncommon for me not to 'be there' for women who book with me. I don't have any dependent children, and have sustained a caseload of 3 or 4 births a month, providing the continuity of care for each woman. The other fairly obvious fact in independent midwifery practice is that we are paid only for what we do. A midwife who misses a birth forgoes the fee that she would have charged. If we take a day 'off' work, we do so without pay.

Some midwives form group practices and agree to cover for each other at certain times, such as one weekend in three. There are obvious benefits, but disadvantages as well. I am happy to discuss this further if anyone wants to engage in discussion.

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